Hx Pancreatitis and elevated liver enzymes

[Jennifer Broad]

Hi There

I have a patient that has hx pancreatitis and “repair” of the pancreas 2017. She does have insulin resistance elevated fasting insulin and preDM2 hgbA1C 5.9. She also has elevated LFTs (transaminitis AST 94 ALT 69) And elevated cholesterol.

Is there a contraindication to using the GLP-1?

She is doing well on BHRT and addressing her stress/adrenals. But she is desiring medical weight loss… any input/recs?

[Miguel Bertonatti]

We’ve seen Elastase-1 get completed supressed after 4-6 month use of GLP-1’s at high doses (aything above 7mgs)

[Kristelle Reyes]

Hello @byurthgmail-com, @drhusaininterlinkedmd-com, @leonard-pastranagmail-com, @drkriswyahoo-com, @andkeller2gmail-com, @dr-siobhannewmangmail-com, and @cpaigepaigemd-com, we would love to have your insights here. Thank you!

[Siobhan Newman, MD]

Hello,

It would be good to know the cause of her Pancreatitis in the first place. Was it do to hyperlipidemia, high TG, Alcohol, stones/obstruction?

Multiple large studies do not prove that the risk of Pancreatitis is higher in GLP-1 use when compared to Placebo.

That being said, I would start low and go slow to the desired effect.

Dr. Siobhan

[Clyde Boswell]

Miguel, did the elastace go back normal when dose GLP-1 was discontinued? Also you said 7mg, are you referring to semaglutide? That’s concerning as it relates to acinar cell damage causing chronic exocrine pancreatic insufficiency.

[Author]

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